Robotic radical cystectomy with intracorporeal neobladder and renal graft nephroureterectomy for urothelial carcinoma in a double renal transplant recipient

Abstract

Objective

To present the first surgical video of robotic radical cystectomy with intracorporeal neobladder in a renal transplant recipient.

Patient and surgical procedure

A 29-year-old solitary kidney male who previously underwent double renal transplants (2016 right and 2020 left iliac fossa) presented to our attention a wide urothelial carcinoma of the distal part of the right graft ureter extending to the bladder. At the transurethral resection, a muscle-invasive high-grade urothelial carcinoma was diagnosed. At the CT scan, the right renal graft appeared functionally excluded while the left one was well-vascularized and functioning, and no lymph node involvement or metastatic disease was reported. The patient was planned for surgery with curative intent. Robotic radical cystectomy, right graft radical nephroureterectomy, prophylactic bilateral native ureterectomy and Florence robotic intracorporeal neobladder (FloRIN) were performed.

Results

The procedure was successfully completed. Technical aspects of the surgery are illustrated in the video. No intra- and postoperative complications were recorded. Blood losses were 200 mL. Operative time was 420 min. The mono J placed to protect the left renal graft was removed after two weeks, while the urinary catheter three weeks after a negative cystogram. The final pathology revealed a bladder pT2a G3 high-grade urothelial carcinoma and a pelvis and ureteral pT1 G3 high-grade urothelial carcinoma with carcinoma in situ. At one year after surgery, the patient was continent, potent, with insignificant residual volume and an unchanged renal function, and disease-free.

Conclusions

In renal transplant recipients, robotic radical cystectomy with intracorporeal neobladder in renal transplant recipients is a safe and feasible procedure, guaranteeing optimal surgical and functional outcomes and a low complications rate.